The way Dr. John A. Kitzhaber sees it, Americans can't afford to sit back and wait for the future of health care to unfold before them; they should assume an active role in shaping its future.
"If people are unable or unwilling to agree among themselves on a vision for the future, the political process cannot and will not do it for themand we will be destined to continue to be shackled to the failed policies of the past," he warned at the November 2007 annual meeting of the Society of Clinical Surgery in Portland, Ore. "By default, we will be allowing our future to become a matter of chance rather than a matter of choice. I think we are better than that."
In January 2006, Dr. Kitzhaber, the former governor of Oregon, founded the Archimedes Movement, a grassroots organization that takes a "we can do better" approach to the governance and delivery of health care. The movement is "committed to providing a safe forum in which citizens and stakeholders alike can be brought together to create a shared vision of a new health care system, a space in which we can ask, 'If anything were possible, what would a better system look like?,'" he said.
The name refers to Archimedes, the mathematician who invented the lever and is reputed to have said, "Give me a lever and a place to stand, and I can move the Earth."
A key strategy of the effort is to agree on what a new health care system should look like, and to expose the contradictions and inequities of the current system and create a "tension" between the status quo and a vision for a new system.
Dr. Kitzhaber, an emergency physician who governed Oregon from 1995 to 2003, said he believes there should be a different standard for the part of health care that is financed by public resources and the portion that is financed by private resources. "We must demand that we get an actual health benefit for the public dollars we allocate for health care, a positive return on investment, [and] the effective and efficient use of public tax dollars. And, since these are public resourcesresources held in commonwe must demand that their allocation benefits all of our citizens, not just some of them; that it does not leave 47 million people behind."
As an example, he said that people who wish to buy an expensive brand name drug when a much cheaper generic is just as effective clinically, and just as safe, should be able to do so with their own personal resources. Public resources should not be used to subsidize the difference in cost. Similarly, he said that expectant parents who want an ultrasound to determine the sex of their unborn child when the procedure is not indicated clinically for a normal term pregnancy should be able to get thatbut again, the cost should not be subsidized with public resources.
To date, the Archimedes Movement has conducted public forums and vision-sharing meetings with more than 3,000 Oregonians in 30 chapters, 13 hospital CEOs, 11 insurer and health plan executives, dozens of physicians and nurses, leaders of national state and labor organizations, and representatives of more than 50 non-health-related businesses in the state.
The resulting consensus led to the Oregon Better Health Act, which was introduced in the 2007 Oregon legislature as Senate Bill 27. It proposes that Oregonians have access to a "core benefit" of essential health services, and seeks to realign financial incentives to ensure fair and reasonable payment to providers, value-based cost sharing for consumers, and a transition to a more efficient delivery system.
Although SB 27 did not pass in the 2007 session, the enthusiasm it generated from citizens and stakeholders propelled the Archimedes Movement into the limelight. It also produced three documents that offer a conceptual framework for a new system in the state and that may serve as a foundation for bringing about national reform. The documentsa Statement of Intent, Principles, and a Frameworkare available at www.wecandobetter.org
The movement provides a space where we can ask, 'If anything were possible, what would a better system look like?' DR. KITZHABER